Provider Demographics
NPI:1992312383
Name:SPECIALIZED HOSPICE, LLC
Entity type:Organization
Organization Name:SPECIALIZED HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MIKALA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LODDER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:816-795-7990
Mailing Address - Street 1:2311 S REDWOOD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2405
Mailing Address - Country:US
Mailing Address - Phone:816-795-7990
Mailing Address - Fax:816-400-1985
Practice Address - Street 1:2311 S REDWOOD AVE STE B
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2405
Practice Address - Country:US
Practice Address - Phone:816-795-7990
Practice Address - Fax:816-400-1985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-29
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based